Steroids for Infant Heart Surgery - Indication and Benefit

Introduction

Heart surgery in infants is done to repair heart defects, and the condition caused by a child after birth requires surgery. This surgery is done for the child’s well-being. Many types of heart defects. Some are minor, and some are major. Defects occur inside the heart and in large blood vessels outside the heart. Some surgeries require immediate surgery right after the infants are born.

Corticosteroids are routinely given to infants who undergo cardiac surgery with CPB (cardiopulmonary bypass) to facilitate the response to inflammation. However, this is controversial, and the decision to administer the intervention varies between the center and the healthcare provider within the center.

What Corticosteroids Are Used in Infants After Cardiac Surgery?

Many infants who undergo congenital heart surgery receive per-operative corticosteroids to reduce postoperative inflammation and to control capillary leaks following the cardiopulmonary bypass. Many proofs show a reduction in many inflammatory markers associated with corticosteroids during, before, and after the surgery.

Impact of corticosteroids on perioperative mortality, potential risk of corticosteroids that include infections and hyperglycemia. Significant reduction in duration of ventilation and intensive care unit stay associated with corticosteroids in infants with congenital heart surgery. The impact of corticosteroids on infants with heart surgery remains unclear and is a matter of debate.

What Is the Indication of Corticosteroids in Pediatric Infant Surgery?

Corticosteroids are mainly used in infant heart surgery with cardiopulmonary bypass. The indications are

1. To blunt the systemic inflammatory response that is induced by extracorporeal circuits.

2. It provides perioperative supplementation that is presumed relative to adrenal insufficiency.

3. The presumed neuroprotective effect that occurs to arrest operations during deep hypothermic circulatory.

The use of corticosteroids in these three overlapping conditions is a matter of discussion.

What Are the Conditions Where Steroids Are Used as Treatment?

Steroids are used to reduce overall systemic inflammation post-infant heart surgery, and this trial included 1200 patients with modified intention-to-treat individuals who received double-blind methylprednisolone or placebo. The most common conditions where steroids are used in infants are atrioventricular septal defect, tetralogy of Fallot, and ventricular septal defect.

Other conditions where steroids are indicated for better outcomes post-surgery are:

1. Post-operative hospital length stays less than 90 days.
2. Renal failure with temporary dialysis.
3. Ventilator support for less than 7 days.
4. Multiple-system organ failure.
5. Postoperative unplanned interventional catheterization.
6. Post-operative cardiac arrest.
7. Preoperative bleeding.
8. Unplanned delayed sternal closure.
9. Postoperative mechanical circulatory support.
10. Unplanned cardiac operation.
11. Multisystem organ failure.
12. Respiratory failure with permanent dialysis.
13. The neurologic deficit persists at discharge.
14. Operative mortality.

Do Corticosteroids Lead To Less Inflammation and Better Clinical Outcomes?

For many years, measured the effect of glucocorticosteroids on markers of inflammation but, importantly, tried to correlate them with the clinical outcomes. Steroids can blunt inflammation, but some others are the opposite.

• It is difficult to characterize the multifaceted nature of SIRS response, a variety of activated cytokines that interact occur in an unpredictable manner.

• The use of corticosteroids is subject between centers and various types of steroids, routes of administration, various regimes, and making a more difficult correlation between clinical outcomes and inflammation.

• Small-sized and displaying a variability between endpoints, the standard corticosteroid regimen recommended to all individuals may not address host inflammatory response but the approach to SIRS.

Are Steroids Worth the Risk?

It is difficult to assess the short-term risk of steroid administration. Some groups of infants have no effect of steroids during their administration after undergoing heart surgery. However, some cases raised concerns about infection and steroid-treated groups.

• Children undergoing heart surgery have no significant benefits from steroids. Steroids are associated with increased mortality and morbidity in low-risk individuals.

• The course of steroid administration is associated with increased rates of sepsis, fractures, and venous thromboembolism.

• Infants with premature lung disease and early administration of steroids harm cognition outcomes and neuromotor effects on children.

• Infants with respiratory distress found steroids associated with delayed development and cerebral palsy incidence.

• Long-term follow-up is aimed at studying the effects of steroids on neurocognition.

How Do Steroids Lead to Benefits in Infant Heart Surgery?

When the steroid comparison is compared to two groups that include postoperative infection and mortality, hospital stay and mechanical ventilation support are:

• The rate of mortality postoperative complications was 17.2 percent for the steroid group and 20.3 percent for the placebo group.

• The mortality rate of infants who received steroids was 2.8 percent for the placebo group and 2 percent for the steroid group.

• Postoperative infections occurred around 5.2 percent in steroid administration, while 4 percent in placebo administration.

• 6.8 percent steroid administration was required to prolong mechanical ventilation, while 8.5 percent was in the placebo group.

• Individuals who received steroids had ten days of hospital stay and 11 days for the placebo group.

• Steroid-administered infants had more risk of high blood sugar, where 19 percent required insulin within surgery, while 6.7 percent of infants in the placebo group required insulin within 24-hour surgery.

Conclusion:

Steroid use in pediatric cardiac surgery in three main areas: adrenal function, neuroprotection, and effect on inflammation. Characterized by the complex inflammation in response to the surgery, the effects of steroids remain limited on the outcomes. However, the significant benefit of corticosteroids is associated with high mortality and morbidity rate and in lowering risk in patients. The potential impact of the different dosing regimens of steroids and the timing of the administration levels may help evaluate and design future trials.